Surgery times for deep plane facelift, upper Bleph, endoscopic brow lift, lip lift, and CO2 resurfacing - what is realistic?

Question

Hi I have received two very different general anesthesia/ surgical times for the above procedures and they are very different. (Both providers are of same age, same tracing, double board certified ENTs, using accredited surgery center with board certified anesthesiologist MD. One has said his total surgery time is 4.5 hours and the other 6.5 hours. I’m concerned one may be going too fast or the other too slow?! What is realistic ?Procedures are: deep plane face/neck lift, upper bleph, lip lift, endoscopic brow lift, CO2 laser at the end).

Carl Truesdale, MD · Answer

Combining deep plane facelift + upper bleph + endoscopic brow lift + lip lift + CO2 resurfacing is what we'd call a 'comprehensive facial rejuvenation' in one operation. Realistic operative time and considerations:
Realistic surgery time:Most experienced surgeons doing all five procedures together: 6 to 9 hours of operative time. Specifically:
Deep plane facelift: 4 to 5 hours.
Endoscopic brow lift: 60 to 90 minutes.
Upper bleph: 30 to 45 minutes.
Lip lift: 30 to 45 minutes.
CO2 resurfacing: 30 to 60 minutes (depends on areas treated).
Total OR time including anesthesia setup, positioning changes, and prep: typically 7 to 10 hours from 'you're under' to 'you're done.'
What this means practically:
Surgery start time: most surgeons start cases like this at 7 to 8 AM to be done by 4 to 6 PM, allowing immediate post-op recovery before nighttime.
Anesthesia: general anesthesia for the whole case. The duration is on the longer end of acceptable for elective cosmetic surgery &mdash; needs an excellent anesthesia team. DVT prophylaxis (compression stockings, sequential pneumatic devices, sometimes pre-op anticoagulation) is critical for long cases.
Surgical facility: should be an AAAHC or AAAASF accredited surgery center, NOT an office-based suite. The longer the case, the more important formal accreditation becomes.
Post-op planning:
Overnight stay at a recovery facility or licensed aftercare facility. NOT recommended to go home same day after this much work.
2 to 3 weeks for major swelling and bruising to resolve.
6 to 8 weeks for full social recovery.
6 to 12 months for final result settling.
Safety considerations:Long operative times have higher rates of DVT/PE risk, hypothermia, anesthetic exposure, and surgical fatigue (surgeon error rate increases past 6 hours).
Best surgeons mitigate by: warming systems, sequential compression devices, accredited facility, short breaks for the surgeon, anesthesia management protocols.
What I'd ask the surgeon:
How many of these combined cases do they do per month.
What's their overnight aftercare arrangement.
What's their DVT prevention protocol.
Their personal complication rate for cases of this length.
The combination you're describing is doable in skilled hands, but it's the high end of what's safe for a single session. Some surgeons prefer to split into two operations (e.g., deep plane + bleph + brow in one, lip lift + CO2 as a smaller second session) for better safety margin. Worth discussing both approaches with the surgeon.

Surgery times for deep plane facelift, upper Bleph, endoscopic brow lift, lip lift, and CO2 resurfacing - what is realistic?

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